A DISCUSSION ON PARKINSON’S DISEASE



A DISCUSSION ON PARKINSON’S DISEASE

Today’s article will consist of two parts. The article today will be a discussion on the signs and symptoms of Parkinson’s disease. Next month’s article will focus on treatment.

Parkinson's disease is a progressive disorder of the nervous system that affects your movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. The tremor typically occurs at rest without any movement. Though tremor may be the most well known sign of Parkinson's disease, other features such as stiffness or slowness to movement and difficulty with balance are just as important. Twenty five percent of patients with Parkinson’s disease do not have a tremor.

In the early stages of Parkinson's disease, your face may show little or no expression or your arms may not swing when you walk. Your speech may become soft. Parkinson's disease symptoms often worsen over time. However, in my experience, some patients can remain very stable over a period of many years. Parkinson's signs and symptoms include:

• Tremor. Tremor or shaking usually begins in one limb- usually the hand but can also be the leg. The classic description is a pill-rolling tremor, which is a back-and-forth rubbing of the thumb and forefinger.

• Slowed movement (bradykinesia). Over time, Parkinson's disease may reduce one’s ability to move and cause slowness to movement, making simple tasks difficult and time-consuming. Patients develop a slow, cautious gait, consisting of small steps associated with shuffling.

• Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion.

• Impaired posture and balance. Parkinson’s disease can cause loss of postural reflexes, which can cause falls.

• Loss of automatic movements. In Parkinson's disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. Patients may no longer gesture when talking.

• Speech changes.  Typical problems with speech include a soft tone to one’s speech. Speech may be more of a monotone rather than with the usual inflections

• Writing changes. Writing may appear small and become difficult.

• Associated symptoms. There are a number of symptoms that are associated with Parkinson’s disease. Difficulty with cognition, sleep abnormalities, swallowing difficulties, depression, bladder difficulties, constipation, blood pressure changes, and difficulty with smell can all be associated with Parkinson’s disease. Some of the above symptoms can be treated with medication.

Typically, no specific tests exist to diagnose Parkinson's disease.  Sometimes MRI imaging and lab work may need to be performed.

TREATMENT OF PARKINSON’S DISEASE

Parkinson's disease can't be cured, but medications can help control your symptoms. In some later cases, surgery may be advised.

Medications:

Medications can help you manage problems with walking, movement, and tremor by increasing your brain's supply of dopamine. However, dopamine can't be given directly, as it can't enter your brain.

You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs can diminish or become less consistent. The dosing schedule or change in the amount of drug given can help with this problem.

• Carbidopa-levodopa.  Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa and this drug is commonly called Sinemet. The carbidopa protects the conversion of levodopa to dopamine outside your brain, which prevents or lessens side effects such as nausea.

Side effects of Sinemet after long-term use are paranoia, delusions, hallucinations, and involuntary movements called dyskinesias. After years, as the disease progresses, the benefit from levodopa may become less stable with a tendency to wax and wane ("wearing off"). Adjustment in the medication may help this side effect.

• Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in your brain. They aren't as effective as levodopa in treating your symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Dopamine agonists include pramipexole, ropinirole, and rotigotine (given as a patch). Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa, but also include leg swelling, sleepiness and compulsive behaviors such as gambling and eating.

• MAO-B inhibitors.  These medications increase dopamine concentration in the brain by inhibiting a brain enzyme called monoamine oxidase B (MAO-B). A drug in this class called rasagiline may decrease the progression of Parkinson’s disease.

• Catechol O-methyltransferase (COMT) inhibitors. Entacapone is the primary medication from this class. This medication mildly prolongs the effect of levodopa by blocking an enzyme that breaks down dopamine. It is often combined with Sinemet.

• Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson's disease to control involuntary movements (dyskinesias) induced by carbidopa-levodopa.

Surgical Procedures:

• Deep brain stimulation.  Deep brain stimulation (DBS) is a procedure where surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson's disease symptoms.

DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesias), reduce tremor, reduce rigidity, and improve slowing of movement. It is also effective in controlling the erratic and fluctuating responses to levodopa that don’t improve with medication adjustments.

If you would like to learn how to care for this disease or any other neurological condition, please call at 609-463-8009 or 609-653-9595. My office is conveniently located at 4 Village Drive in Cape May Court House and 160 Shore Road in Somers Point.

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